Ontario could see between 3,000 and 15,000 COVID-19 deaths over two years, projection shows

If Ontario maintains public health measures, the province could still see between 3,000 and 15,000 deaths from COVID-19 over the full course of the pandemic, health officials revealed on Friday — as Canada’s most populous province lifted the curtain on the data informing officials’ decisions.

The stark figures were pitted against a much more dire projection. Without public health measures, including those already introduced, the analysis showed deaths reaching 100,000. Peter Donnelly, CEO of Public Health Ontario, said this outbreak may last for between 18 months and two years.

“I think it’s important that we are all robustly realistic about the scale of the challenge we face,” Donnelly said. The projection released on Friday was compiled by Ontario Health, Public Health Ontario and university researchers. “There is a range, because where we end up depends on all of us.”

Premier Doug Ford, shortly after the predictions went public, labelled them as “stark” and “sobering” — but also noted that the data could change, based on actions taken by the public and governments.

Three possible scenarios were outlined for how the outbreak moves over the course of April — though projections are inexact, as they include some assumptions, can fluctuate, and become less precise the further out modelling goes. With no intervention, the model showed 6,000 cases developing by April 30 that would eventually result in deaths, 4,400 of which were listed as “prevented by current action.”

With current levels of intervention by April 30, 1,600 deaths have been predicted. And with “full” future intervention — a level that may include moves like enhancing non-compliance enforcement; reducing how many workplaces are allowed to stay open, which the province has faced calls to do; and restricting entry to First Nations and other communities — the death tally predicted was 200.

With current levels of intervention, 80,000 people in Ontario are projected to contract COVID-19 by April 30. With more fullsome intervention measures, that number could drop down to 12,500.

Ford, on Friday, announced that the province would whittle down its essential business list, effective this weekend. Since Ontario’s initial “essential” businesses list was published, Ford and his PCs have faced questions about the construction sector in particular, which was largely permitted to proceed.

The new order limits industrial construction to projects deemed “critical,” Ford said Friday, and limits infrastructure projects to things like hospitals and transportation. No new residential construction will be permitted, though work can continue where footing permits have been granted for single-family, semi-detached and town homes. Condo construction can also continue with above grade structural permits.

The new projections also showed that, even in a best case scenario, COVID-19 cases in Ontario will exceed the province’s currently available ICU capacity. At the time the data was compiled, just 410 ICU beds were available in Ontario to handle more COVID-19 patients. In a best case scenario, the projections show that number surpassed by Sunday, moving into the realm of the 900 “expansion capacity” beds that officials believe can be accessed. A best case scenario showed Ontario staying beneath expansion capacity, but the worst case showed need more than doubling capacity by April 30.

The province has been developing what’s called an “ethical framework” to handle worst-case situations where need might exceed capacity — laying out how health-care professionals would deploy potentially life-saving supports like ventilators, if more patients needed them than were available. Officials have said their model won’t be based on age, though that stance has drawn some criticism.

On Friday, Donnelly called the data around mortality rates for patients over 80 years old “striking,” noting that so far in Ontario, Ontario patients in that age bracket had a mortality rate of 16 per cent.

“We must focus on protecting the elderly,” he stressed. Ford, too, appealed for public compliance with social distancing recommendations during his afternoon remarks. “Is a life worth a picnic in the park? … Is a life worth having a few cold ones with your buddies in the basement?” he asked.

So far, the official data about COVID-19 cases requiring intensive care falls lower than both best and worst case projections. The projection data shows a total of 3,255 total cases and 67 deaths in Ontario, the same figures listed on the province’s website Friday afternoon. Hospitalized patients tallied 462, with 194 in ICU and 140 on ventilators. The province’s data has been criticized recently for lagging behind the data collectively being reported by its local public health units. Donnelly acknowledged the frustration caused by inconsistencies on Friday. But he claimed their system, based on the province’s integrated Public Health Information System, was the best way to track the outbreak over time.

The new projection estimates how many lives have been safeguarded by existing public health measures, such as school closures, altered policies for long-term care, social distancing and modified arrangements within the correctional system. Some 220,000 cases that could have emerged by April 30 were predicted to have been prevented by current actions, including the 4,400 deaths officials believe were circumvented. Still, Adalsteinn Brown, dean of the University of Toronto’s Dalla Lana School of Public Health, cautioned Friday that “these measures only work if people follow them.”

Similar projections have not yet been released at a national level, with Prime Minister Justin Trudeau facing pressure to do so in recent days. Facing questions Friday, Trudeau said the feds were working with the provinces to build “a robust model” to show projections. “We need to make sure that the projections that we will be releasing are based on the most accurate, the deepest, the most properly collated information out there,” Trudeau said, adding shortly afterwards that he didn’t intend to “pre-empt” the announcement that Ford and Ontario officials would be making Friday afternoon.

“There are some very challenging projections out there that will emphasize how important it is for all of us to do our part to stay home, to keep ourselves safe to keep our loved one safe,” Trudeau said.

Ford, asked Friday whether he’d discussed releasing the national data with Trudeau, told reporters that he felt he was “in no position” to tell the prime minister what to do — nor instruct Canada’s other premiers. “I just personally feel it’s the right of the people of Ontario to know what I know,” he said.

“It’s going to be up to the prime minister to make his decision for the people of this country.”